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What Causes Bad Breath?

I'm a healthy guy in my 20s. I exercise, get plenty of sleep and I have a fairly healthy diet. But I do have one embarrassing problem. As much as I brush and floss my teeth, I always have horrendous breath. I'm not talking about a little morning breath — it's as though a pig ate rotten food and then defecated into my mouth. I'm always too embarrassed to stand close to people when I talk. As a result, I come off as being unfriendly or standoffish. What can I do to get rid of this swamp breath? — Wayne L., NY, NY

You describe a condition called "halitosis," or in your case, "pig turd breath." Chronic bad breath (as opposed to the occasional morning breath, or a post-liver-and-onions train wreck) affects millions of people in the world, and is defined as awful breath that can't be fixed with simple brushing or mouthwash.

The causes of halitosis are legion, but it's estimated that 90% of the problems occur inside the mouth. Bacteria in the mouth break down proteins that release sulfur compounds into the atmosphere. Sulfur is the element that contributes to the delightful smell of farts, so you can imagine what this does coming out of your mouth. Causes of flatus-breath include plaque buildup, broken down dental work, dry mouth, or bacterial growth on the back part of the tongue. There are some people with "crypts" (cave-like openings) in their tonsils that make nasty smelling stone-like things called "tonsil nuggets" or "tonsilliths" that can make your breath smell like something from the nether regions of hell. The other 10% of cases are caused by sinus infections, reflux of stomach acid, or problems with the liver, kidneys, or pancreas.

If you've tried scraping your tongue and you don't have any other medical problems, your first trip should be to your dentist. (Don't have one? No wonder your breath stinks.) The dentist and hygienist will examine your teeth for plaque or bad dental work, your gums for gingivitis, and will even look at your tonsils and see if there are tonsil nuggets hiding in there. If they can find a reversible cause, they'll treat it immediately. If they can't, they may refer you to a medical provider to make sure there isn't a non-oral problem causing your horrid breath.

If you find that you have tonsil nuggets, they are easily treated by cleaning out the crypts with a "water pik." Daily maintenance is required to keep food and dried mucus from gathering in these meat caves, where they just rot and stink up your mouth. Extreme cases with chronic infection of the tonsils would be an indication to see an Ear Nose and Throat surgeon for a consultation.

In the meantime, you can always simply chew gum. Although it is considered unprofessional in some circles and can contribute to jaw pain and problems with dental work, it can keep your breath under control until you can be seen by your dentist to get things started.

**Remember, don't do anything you read here without first consulting with your own health care provider.**

Dr. Steve is the resident medical expert for the Opie and Anthony and Ron and Fez shows, and the host of his own Sirius XM Radio program, Weird Medicine.